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August 14, 2012

This might hurt: Negative words can trigger the 'nocebo effect'

Daily Briefing

    A few poorly chosen words or phrases from physicians and nurses can convince patients that they are suffering deadly side effects, a condition known as the "nocebo effect," HealthDay reports.

    While the placebo effect can help patients feel better with just the thought that their ailment is being cured, the lesser-known nocebo effect can have the opposite effect when physicians mention pain, express uncertainty about a medication's ability to treat an ailment, or make other negative comments.

    report in Deutsches Arzteblatt International reviews existing research on the nocebo effect. In one study, researchers told one cohort of patients with back pain that a leg-flexing test could boost their pain slightly but told another cohort that it would not affect their pain. The first cohort reported more pain and did not perform well on the test.

    Physicians can trigger the nocebo effect when they emphasize negative possibilities, saying things like:

    • "You are a high-risk patient;"
    • "This medication may help;"
    • "Signal if you feel pain;" and
    • "You don't need to worry."

    Patients are highly receptive to "negative suggestion, particularly in situations perceived as existentially threatening, such as impending surgery, acute severe illness, or an accident," researchers conluded. Patients in extreme situations are often in a "natural trance state" that can make them "vulnerable to misunderstandings arising from literal interpretations, ambiguities and negative suggestion."

    According to Winfried Hauser, the report's lead author, physicians should learn how to better "exploit the power of words" to combat the nocebo effect. Overall, the report recommends limiting information on negative side effects to patients.

    As a result, physicians must walk a fine ethical line when sharing information with patients, according to Ted Kaptchuk, an associate professor of medicine at Harvard Medical School who studies the placebo effect. 

    "This is a fundamental issue in all health care," says Kaptchuk. "Honesty versus harm" (Dotinga, HealthDay, 8/10).

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    1. Current ArticleThis might hurt: Negative words can trigger the 'nocebo effect'

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